Provider Demographics
NPI:1013279991
Name:GOPAL, SUNDEEP
Entity Type:Individual
Prefix:MR
First Name:SUNDEEP
Middle Name:
Last Name:GOPAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 77TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2811
Mailing Address - Country:US
Mailing Address - Phone:206-232-2222
Mailing Address - Fax:206-232-6485
Practice Address - Street 1:2755 77TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2811
Practice Address - Country:US
Practice Address - Phone:206-232-2222
Practice Address - Fax:206-232-6485
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00053805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist